Advanced Breast Cancer Guidelines in Latin America: Assessment, Adaptation, and Implementation of Fifth Advanced Breast Cancer Consensus Guidelines

PURPOSE

As the fifth international consensus on advanced breast cancer (ABC5) established guidelines for the management of this disease, the aim of this article was to present the applicability of the consensus recommendations and to generate knowledge to improve access.

METHODS

Sixty-one recommendation statements were selected and discussed by 15 breast cancer experts from Latin America (LA). After the discussion, the level of consensus was determined through a vote. In addition to this, the level of access to each of the recommendations presented, according to the country and health system, was exposed.

RESULTS

Latin American experts had a high level of agreement with the ABC5 consensus recommendations (range, 83%-100%). Twelve of 61 statements are not available for all patients in LA. Among the limitations to access, the following ones are described: limited access to certain technologies (stereotactic body radiotherapy, positron emission tomography-computed tomography), the high costs of drugs that limits access to treatment with CDK4/6 inhibitors, pertuzumab, or poly(ADP-ribose) polymerase inhibitors, and the lack of molecular tests for access to therapeutic targets, as well as the difficult geography and cultural diversity of our continent.

CONCLUSION

Despite the great relevance of the recommendations of the ABC5 consensus guidelines, we highlight that we still need to improve access for all patients, regardless of the country or health system they are in, for which we call to action to policy makers and patient groups to improve clinical outcomes of patients with advanced breast cancer in our region.

Integrating EM and Patch-seq data: Synaptic connectivity and target specificity of predicted Sst transcriptomic types

Neural circuit function is shaped both by the cell types that comprise the circuit and the connections between those cell types ¹ . Neural cell types have previously been defined by morphology ^{2, 3} , electrophysiology ^{4, 5} , transcriptomic expression ^6-8 , connectivity ^9-13 , or even a combination of such modalities ^14-16 . More recently, the Patch-seq technique has enabled the characterization of morphology (M), electrophysiology (E), and transcriptomic (T) properties from individual cells ^17-20 . Using this technique, these properties were integrated to define 28, inhibitory multimodal, MET-types in mouse primary visual cortex ²¹ . It is unknown how these MET-types connect within the broader cortical circuitry however. Here we show that we can predict the MET-type identity of inhibitory cells within a large-scale electron microscopy (EM) dataset and these MET-types have distinct ultrastructural features and synapse connectivity patterns. We found that EM Martinotti cells, a well defined morphological cell type ^{22, 23} known to be Somatostatin positive (Sst+) ^{24, 25} , were successfully predicted to belong to Sst+ MET-types. Each identified MET-type had distinct axon myelination patterns and synapsed onto specific excitatory targets. Our results demonstrate that morphological features can be used to link cell type identities across imaging modalities, which enables further comparison of connectivity in relation to transcriptomic or electrophysiological properties. Furthermore, our results show that MET-types have distinct connectivity patterns, supporting the use of MET-types and connectivity to meaningfully define cell types.

Triple-Negative PAM50 Non-Basal Breast Cancer Subtype Predicts Benefit from Extended Adjuvant Capecitabine

PURPOSE

Predictive biomarkers for capecitabine benefit in triple-negative breast cancer (TNBC) have been recently proposed using samples from phase III clinical trials, including non-basal phenotype and biomarkers related to angiogenesis, stroma, and capecitabine activation genes. We aimed to validate these findings on the larger phase III GEICAM/CIBOMA clinical trial.

EXPERIMENTAL DESIGN

Tumor tissues from patients with TNBC randomized to standard (neo)adjuvant chemotherapy followed by capecitabine versus observation were analyzed using a 164-gene NanoString custom nCounter codeset measuring mRNA expression. A prespecified statistical plan sought to verify the predictive capacity of PAM50 non-basal molecular subtype and tested the hypotheses that breast tumors with increased expression of (meta)genes for cytotoxic cells, mast cells, endothelial cells, PDL2, and 38 individual genes benefit from adjuvant capecitabine for distant recurrence-free survival (DRFS; primary endpoint) and overall survival.

RESULTS

Of the 876 women enrolled in the GEICAM/CIBOMA trial, 658 (75%) were evaluable for analysis (337 with capecitabine and 321 without). Of these cases, 553 (84%) were profiled as PAM50 basal-like whereas 105 (16%) were PAM50 non-basal. Non-basal subtype was the most significant predictor for capecitabine benefit [HRcapecitabine, 0.19; 95% confidence interval (CI), 0.07-0.54; P < 0.001] when compared with PAM50 basal-like (HRcapecitabine, 0.9; 95% CI, 0.63-1.28; P = 0.55; Pinteraction<0.001, adjusted P value = 0.01). Analysis of biological processes related to PAM50 non-basal subtype revealed its enrichment for mast cells, extracellular matrix, angiogenesis, and features of mesenchymal stem-like TNBC subtype.

CONCLUSIONS

In this prespecified correlative analysis of the GEICAM/CIBOMA trial, PAM50 non-basal status identified patients with early-stage TNBC most likely to benefit from capecitabine.

Applying Deep Learning Cancer Subtyping Algorithms Trained on Physical Slides to Multiphoton Imaging of Unembedded Samples

Introduction/Objective

Deep learning algorithms on digital images of physical tissue slides have shown potential improvements in accuracy and precision of diagnostic interpretation of neoplastic histology. Clustering-constrained- attention multiple-instance learning (CLAM) is one such method that identifies diagnostic sub-regions to accurately classify whole slides. Often, algorithm performance degrades when deployed on datasets that differ from the original set and it is subject to physical slide preparation variability. New multiphoton imaging modalities have potential workflow and quality advantages over physical slides, producing images analogous to whole slide imaging (WSI) without cutting artifacts, but performance of existing algorithms trained on digitized physical slides and applied to multiphoton images remains completely unknown. Given this, we aimed to test the performance of CLAM algorithms for subtyping renal cell carcinoma (RCC) and lung cancer (LC) applied to pseudo-colored multiphoton WSI.

Methods/Case Report

Clinical RCC and LC surgical resection samples were processed and imaged by Clearing Histology with MulitPhoton microscopy (CHiMP, Applikate Technologies, Fairfield, CT), producing digital images of un- cut, un-embeded tissue to generate H&E-like optical slices. Multiphoton images were downscaled to 0.5 um/px to match algorithm target resolution. CLAM models for subtyping RCC (chromophobe, clear cell, papillary) and LC (squamous & adenocarcinoma) previously trained using TCGA and CPTAC whole slide images of physical slides were applied directly to CHiMP multiphoton images without adjustment. Reference cancer subtype classifications were provided from physical and digital slides.

Results (if a Case Study enter NA)

For the subtypes included during training, multiphoton WSIs of RCC and LC were accurately subtyped by the CLAM models without stain normalization nor network fine tuning producing high prediction levels. Subtypes not included during the training (namely oncocytoma for RCC) resulted in low scoring model predictions (below 0.85), indicating specificity of identification. Multiple slide levels improved interpretation of several difficult cases for CLAM predictions.

Conclusion

This preliminary data suggests that CLAM models trained on standard H&E WSIs for RCC and LC subtyping are applicable to pseudo-H&E multiphoton WSIs without domain adaptations. This implies that diagnostic histologic features have been learned by these CLAM models and are efficiently recognized in digital histology images produced via CHiMP.

Perceived stress and physiological consistency during mental stress exercises and controlled breathing

Introduction

The measurement of the physiological coherence, the order and the quality of the connection of complex systems such as the cardiac and the respiratory system, varies in situations of stress and relaxation.

Objectives

We aim to assess changes in physiological coherence and perception of stress during mental stress and directed breathing exercises.

Methods

Repeated-measures study in healthy adults without prior training in breathing techniques, aged between 18 and 65 years of both sexes who were evaluated in three situations: baseline, mental stress (Stroop test and successive subtractions), and directed breathing, during which were captured heart rate and respiratory signals to estimate physiological coherence and the participants rated the perceived stress at each moment.

Results

34 participants were analyzed, 59% women, with a median age of 36 years (Rq = 13). During mental stress tasks, the median for physiological coherence was similar to baseline coherence but increased significantly with five minutes of directed breathing exercises (38% vs. 63% p <0.0001). The highest perception of stress was during successive subtractions (Me 7, Rq = 4) and the lowest during directed breathing exercises (Me 2 Rq = 3.0). The correlation was sought between physiological coherence and perception of stress during each of the four moments of the study. Basal (Rho Spearman -0.05, p 0.54); Stroop (Rho -0.17, p 0.03); successive subtractions (Rho 0.50, p 0.77); and directed breathing (Rho -0.28, p 0.09).

Conclusions

A correlation was found between physiological coherence and perception of stress during the Stroop test; however, no association was found.

Disclosure

No significant relationships.

Preliminary Pharmacogenomic-Based Predictive Models of Tamoxifen Response in Hormone-dependent Chilean Breast Cancer Patients

Tamoxifen (TAM), a selective oestrogen receptor modulator, is one of the most used treatments in oestrogen receptor-positive (ER+) early and metastatic breast cancer (BC) patients. The response to TAM has a high degree of inter-individual variability. This is mainly due to genetic variants in CYP2D6 gene, as well as other genes encoding proteins involved in the TAM pharmacokinetic and/or pharmacodynamic. Therefore, prediction of the TAM response using these genetic factors together with other non-genetic variables may be relevant to improve breast cancer treatment. Thus, in this work, we used genetic polymorphisms and clinical variables for TAM response modelling. One hundred sixty-two ER + BC patients with 2 years of TAM treatment were retrospectively recruited, and the genetic polymorphisms CYP2D6*4, CYP3A4*1B (CYP3A4*1.001), CYP3A5*3, UGT2B7*2, UGT2B15*2, SULT1A1*2, and ESRA V364E were analyzed by PCR-RFLP. Concomitantly, the therapeutic response was obtained from clinical records for association with genotypes using univariate and multivariate biostatistical models. Our results show that UGT2B15*1/*2 genotype protects against relapse (OR = 0.09; p = 0.02), CYP3A5*3/*3 genotype avoids endometrial hyperplasia (OR = 0.07; p = 0.01), SULT1A1*1/*2 genotype avoids vaginal bleeding (OR = 0.09; p = 0.03) and ESRA 364E/364E genotype increases the probability of vaginal bleeding (OR = 5.68; p = 0.02). Logistic regression models, including genomic and non-genomic variables, allowed us to obtain preliminary predictive models to explain relapse (p = 0.010), endometrial hyperplasia (p = 0.002) and vaginal bleeding (p = 0.014). Our results suggest that the response to TAM treatment in ER + BC patients might be associated with the presence of the studied genetic variants in UGT2B15, CYP3A5, SULT1A1 and ESRA genes. After clinical validation protocols, these models might be used to help to predict a percentage of BC relapse and adverse reactions, improving the individual response to TAM-based treatment.

Asociación Mexicana de Hepatología A.C. Clinical guideline on hepatitis B

Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.

Asociación Mexicana de Hepatología A.C. Clinical guideline on hepatitis B

Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.

P–403 Sodium tungstate increases embryo adhesion through a direct effect on endometrial cells

Study question

Does sodium tungstate treatment induce a change in endometrial cells’ capacity to implant trophoblasts?

Summary answer

Administration of sodium tungstate to endometrial cells increases trophoblast adhesion.

What is known already

Sodium tungstate (ST) has shown its capacity to modulate the activity of cytokines, such as leptin, an activator of an obligatory signalling cascade in the embryo-implantation process. STAT3, a signal transducer molecule critical for the embryo implantation process, is also known to be activated by ST. Still, ST’s effect on implantation using biological systems has never been studied. Embryo implantation process and endometrium roles are complicated to study in vivo due to a lack of animal models and appropriate techniques. In vitro techniques using immortalised cell lines allows a first approach to study early implantation stages, such as embryo adhesion.

Study design, size, duration

An in vitro study was carried out using a human endometrial carcinoma cell line (HEC–1-A) treated with sodium tungstate for 24 and 48h, and choriocarcinoma cell spheroids (JAr). Different times of treatment and concentrations were studied. Each experiment was performed in triplicate.

Participants/materials, setting, methods

Confluent endometrial HEC–1-A cultures were treated with ST at concentrations (0–150mM) and withaferin A (1mM), negative control for embryo adhesion. After the treatment period, HEC–1-A cultures were washed with ST-free culture medium to eliminate ST. Immediately, 15 JAr trophoblast spheroids were added to cultures and coincubated with gentle agitation for 30, 60 and 90 minutes. An inverted light microscope was used to count adhered and floating spheroids, and determine the trophoblast adherence ratio.

Main results and the role of chance

HEC–1-A cells treated with ST showed normal morphology and growth at all doses except 150mM. At the highest dose tested, the cells’ culture was still viable (negative blue trypan staining) and maintained morphology, but the adhesion to the plate surface was affected. Doses from 0.15 to 15mM were used to perform adhesion assays.

HEC–1-A cells treated with ST for 24h showed an increased capacity to adhere JAr trophoblast spheroids. Adhesion rates reached significant differences at doses of 1.5 and 15mM after 60 and 90 minutes of coincubation. After 90 minutes, untreated cells reached 32.8% adhesion rate, while 1.5 and 15mM ST-treated cells reached 54.6% and 53.4% respectively (p &lt; 0.05 ST vs untreated). Thus, the increment of trophoblast adhesion rate induced by ST reached 66%. Lower adhesion rates were observed after 60 minutes of coincubation but were also significant with a relative increase of 49.1% at 1.5mM and 50.5% at 1.5mM when compared with untreated cells (p &lt; 0.05)

Longer treatments (48h) showed similar trends to 24h-treatments, but with a lower extent of ST effect on HEC–1-A receptivity. Maximum adhesion rates were also observed at 90 minutes of coincubation and 1.5 and 15mM doses. The Mean adhesion rate increase was &gt;40% with both doses. Limitations, reasons for caution: The current study is the first approach to evaluate sodium tungstate effect on endometrium using an in vitro model. Future research using in vivo models should be performed to assess sodium tungstate effect on endometrium receptivity and its potential as a fertility treatment.

Wider implications of the findings: We conclude that the direct effect of sodium tungstate on endometrial cells increases embryo adhesion rate. These results open a new research line to a potential treatment in human reproduction management with sodium tungstate to solve the unmet need of inducing embryo implantation.

Trial registration number

Not applicable

Effects of sub-optimal illumination in plants. Comprehensive chlorophyll fluorescence analysis

The fluorescence signals emitted by chlorophyll molecules of plants is a promising non-destructive indicator of plant physiology due to its close link to photosynthesis. In this work, a deep photophysical study of chlorophyll fluorescence was provided, to assess the sub-optimal illumination effects on three plant species: L. sativa, A. hybridus and S. dendroideum. In all the cases, low light (LL) treatment induced an increase in pigment content. Fluorescence ratios - corrected by light reabsorption processes - remained constant, which suggested that photosystems stoichiometry was conserved. For all species and treatments, quantum yields of photophysical decay remained around 0.2, which meant that the maximum possible photosynthesis efficiency was about 0.8. L. sativa (C3) acclimated to low light illumination, displayed a strong increase in the LHC size and a net decrease in the photosynthetic efficiency. A. hybridus (C4) was not appreciably stressed by the low light availability whereas S. dendroideum (CAM), decreased its antenna and augmented the quantum yield of primary photochemistry. A novel approach to describe NPQ relaxation kinetics was also presented here and used to calculate typical deactivation times and amplitudes for NPQ components. LL acclimated L. sativa presented a much larger deactivation time for its state-transition-related quenching than the other species. Comprehensive fluorescence analysis allowed a deep study of the changes in the light-dependent reactions of photosynthesis upon low light illumination treatment.

AB0688 GAIT PATTERN DIFFERENCES BETWEEN PATIENTS WITH RADIOGRAPHIC AND NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS, THE MyoSpA STUDY

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease classified as radiographic (r-axSpA) or non-radiographic (nr-axSpA). Defining the gait patterns associated with these two groups can improve its detection and promote early intervention. In normal walking, body segments move around the joints as struts of an inverted pendulum. The resultant cyclic rotations contribute to the forward translation of the body, while minimizing muscle work and maintaining stability. Recent literature describes a decline in this pendulum-like mechanism associated with aging and some neurological diseases (Parkinson and multiple sclerosis).

Objectives:

The aim was to compare the 3D gait kinematics of patients with r-axSpA and nr-axSpA.

Methods:

A cross-sectional study was conducted on 54 participants (18-50 years old), 27 patients with axSpA (according to ASAS criteria, with less than 10 years since symptoms onset) and 27 healthy controls, matched by gender, age and level of physical activity. A sub-analysis was performed involving the whole group of patients classified as r-axSpA (n=14) and nr-axSpA (n=6). Subjects movement was reconstructed using a 3D full-body kinematic model (Kinetikos, Coimbra, Portugal) fed by 15 inertial sensors placed in the head, arms, trunk, pelvis, thighs, shanks and feet. 3D gait kinematics was characterised based on variables that analyse the body movement as a whole (e.g. center of mass displacement, speed), conventional spatiotemporal parameters (e.g. stance/swing time, step length) and joints kinematics time-normalized to 101 points, comprising the gait cycle from 0 to 100%. Nonparametric statistical tests were used.

Results:

In the r-axSpA group, 71,4% were male, with a mean age of 34.43±7.84 years and a BASDAI of 2.84±2.39, whereas in the nr-axSpA, 50% were male, with a mean age of 41.83±6.27 years and a BASDAI of 2.99±0.58. A statistically significant difference was observed in the displacement of the center of mass (with respect to the pelvis local coordinate system) along the anteroposterior axis between the two studied groups (H = 4.96, p = 0.03), with a mean rank displacement of 8.6 for r-axSpA and 15.00 for nr-axSpa, corresponding to a reduction in displacement of 38% (mean 0.00986 vs 0.01579m), in the r-axSpa group.

Conclusion:

Our preliminary results in r-axSpA subjects show a reduction of the pendulum mechanism. Although no significant segmental (kinematics) changes were observed, the sum of all studied variables result in a clear different gait pattern between the two groups. The observed decline can be an early sign of the inefficiency of the r-axSpA group to minimise the cost of transport of the center of mass during walking (i.e. increased instability). This study shows the potential of gait analysis to identify subjects who may benefit from early physiotherapy intervention.

Disclosure of Interests:

Nuno Gonçalves: None declared, Lúcia Domingues: None declared, Atlas Mashayekhi Sardoo: None declared, Lucian Radu: None declared, Santiago Rodrigues-Manica Speakers bureau: Jansse, MSD, Novartis, Agna Neto: None declared, Rita Torres: None declared, José Marona: None declared, Jaime Branco Speakers bureau: Vitoria, César Mendes: None declared, Ricardo Matias: None declared, Fernando Pimentel dos Santos Speakers bureau: Novartis, Pfizer, Biogen, Vitoria,

Phase III Trial of Adjuvant Capecitabine After Standard Neo-/Adjuvant Chemotherapy in Patients With Early Triple-Negative Breast Cancer (GEICAM/2003-11_CIBOMA/2004-01)

PURPOSE

Operable triple-negative breast cancers (TNBCs) have a higher risk of relapse than non-TNBCs with standard therapy. The GEICAM/2003-11_CIBOMA/2004-01 trial explored extended adjuvant capecitabine after completion of standard chemotherapy in patients with early TNBC.

PATIENTS AND METHODS

Eligible patients were those with operable, node-positive—or node negative with tumor 1 cm or greater—TNBC, with prior anthracycline- and/or taxane-containing chemotherapy. After central confirmation of TNBC status by immunohistochemistry, patients were randomly assigned to either capecitabine or observation. Stratification factors included institution, prior taxane-based therapy, involved axillary lymph nodes, and centrally determined phenotype (basal v nonbasal, according to cytokeratins 5/6 and/or epidermal growth factor receptor positivity by immunohistochemistry). The primary objective was to compare disease-free survival (DFS) between both arms.

RESULTS

Eight hundred seventy-six patients were randomly assigned to capecitabine (n = 448) or observation (n = 428). Median age was 49 years, 55.9% were lymph node negative, 73.9% had a basal phenotype, and 67.5% received previous anthracyclines plus taxanes. Median length of follow-up was 7.3 years. DFS was not significantly prolonged with capecitabine versus observation [hazard ratio (HR), 0.82; 95% CI, 0.63 to 1.06; P = .136]. In a preplanned subgroup analysis, nonbasal patients seemed to derive benefit from the addition of capecitabine with a DFS HR of 0.53 versus 0.94 in those with basal phenotype (interaction test P = .0694) and an HR for overall survival of 0.42 versus 1.23 in basal phenotype (interaction test P = .0052). Tolerance of capecitabine was as expected, with 75.2% of patients completing the planned 8 cycles.

CONCLUSION

This study failed to show a statistically significant increase in DFS by adding extended capecitabine to standard chemotherapy in patients with early TNBC. In a preplanned subset analysis, patients with nonbasal phenotype seemed to obtain benefit with capecitabine, although this will require additional validation.

Graphene and its derivatives: Opportunities and challenges in dentistry

The emerging science of graphene-based engineered nanomaterials as either nanomedicines or dental materials in dentistry is growing. Apart from its exceptional mechanical characteristics, electrical conductivity and thermal stability, graphene and its derivatives can be functionalized with several bioactive molecules, allowing them to be incorporated into and improve different scaffolds used in regenerative dentistry. This review presents state of the art graphene-based engineered nanomaterial applications to cells in the dental field, with a particular focus on the control of stem cells of dental origin. The interactions between graphene-based nanomaterials and cells of the immune system, along with the antibacterial activity of graphene nanomaterials are discussed. In the last section, we offer our perspectives on the various applications of graphene and its derivatives in association with titanium dental implants, membranes for bone regeneration, resins, cements and adhesives, as well as tooth-whitening procedures.

Abstract GS2-04: Efficacy results from CIBOMA/2004-01_GEICAM/2003-11 study: A randomized phase III trial assessing adjuvant capecitabine after standard chemotherapy for patients with early triple negative breast cancer

Background: Triple negative breast cancers (TNBC) have a greater risk of relapse than non-TNBC. New therapeutic approaches are needed for these patients (pts). CIBOMA/2004-01_GEICAM/2003-11 is a multinational, randomized phase III trial exploring adjuvant capecitabine (X) after completion of standard treatment in early TNBC pts.

Materials and Methods: Patients with operable, node-positive (or node-negative with tumor size ≥ 1 cm), centrally confirmed hormone receptor-negative, HER2-negative early BC, who had received 6–8 cycles (cy) of standard anthracycline and/or taxane-containing chemotherapy or 4 cy of doxorubicin-cyclophosphamide (for node-negative disease) in the (neo)adjuvant setting, were eligible. Patients were randomized to either 8 cy of X (1,000 mg/m2 bid, days 1–14, every 3 weeks) or observation. Stratification factors included center, prior taxane-based therapy, number of involved axillary lymph nodes and phenotype (basal vs non-basal, according to cytokeratins 5/6 and/or EGFR positivity). The primary objective was to compare the disease-free survival (DFS) between both treatment arms, and secondary objectives included the comparison in terms of 5-year DFS, overall survival (OS) and safety. Assuming a 30% risk reduction in DFS rate at 5 years (from 64.7% to 73.7%, hazard ratio 0.70) with 80% power and a two-tailed log-rank test at 0.05, 834 evaluable pts were needed. 876 pts had to be finally enrolled considering a drop-out rate of 5%.

Results: Recruitment of 876 pts from 8 countries was completed in September 2011. Median age was 49 years; 68.5% of pts were postmenopausal, 55.5% were lymph node negative, 71.7% had a basal phenotype, 67.5% received chemotherapy based on anthracyclines and taxanes. Median follow-up was 7.3 years (range 0.0 to 11.1). DFS was not significantly prolonged with X vs observation (hazard ratio (HR) 0.82; 95% confidence interval (CI), 0.63 to 1.06; P=0.1353). Five-year DFS was 79.6% (95% CI, 75.8% to 83.4%) with X and 76.8% (95% CI, 72.7% to 80.9%) with observation. OS was not statistically different between treatment arms (HR 0.92; 95% CI, 0.66 to 1.28; P=0.6228). In subgroup analysis for DFS, we found no statistically significant interaction between X treatment and different subgroups, with the exception of basal vs non-basal phenotypes (basal HR 0.97, 95% CI 0.72 to 1.32, P=0.8620; non-basal HR 0.51, 95% CI, 0.31 to 0.86, P=0.0101; interaction P=0.0357). Similar results were found for OS (basal HR 1.20, 95% CI 0.81 to 1.77, P=0.3684; non-basal HR 0.48, 95% CI, 0.26 to 0.91, P=0.0205; interaction P=0.0155). 75.2% of pts completed 8 cy of X, with a median relative dose intensity of 86.3%. Grade (G) 3 or higher adverse events (AEs) were observed in 40.4% of pts in X arm. In 9.6% of pts the AEs were related with X. Hand-foot syndrome was the most common AE in X arm (G3 on 18.8% of pts).

Conclusions: In our study, the addition of adjuvant X after standard (neo) adjuvant anthracycline and/or taxane-containing chemotherapy was not associated with a statistically significant improvement of DFS or OS compared to observation in pts with early TNBC. However, in a subgroup analysis a significant DFS and OS improvement was observed with X in pts with non-basal phenotype.

Sponsor: CIBOMA.

Citation Format: Martín M, Barrios CH, Torrecillas L, Ruiz-Borrego M, Bines J, Segalla J, Ruiz A, García-Sáenz JA, Torres R, de la Haba J, García E, Gómez HL, Llombart A, Rodríguez de la Borbolla M, Baena JM, Barnadas A, Calvo L, Pérez-Michel L, Ramos M, Castellanos J, Rodríguez-Lescure A, Cárdenas J, Vinholes J, Martínez de Dueñas E, Godes MJ, Seguí MA, Antón A, López-Álvarez P, Moncayo J, Amorim G, Villar E, Reyes S, Sampaio C, Cardemil B, Escudero MJ, Bezares S, Carrasco E, Lluch A. Efficacy results from CIBOMA/2004-01_GEICAM/2003-11 study: A randomized phase III trial assessing adjuvant capecitabine after standard chemotherapy for patients with early triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS2-04.

Genetic parameters for medullated fiber and its relationship with other productive traits in alpacas

The alpaca fiber diameter (FD) varies from 18 to 36 μm, being the finer fiber categories highly appreciated. However, the alpaca fiber presents some limitations in the textile industry due to the high incidence of fiber medullation and diameter variability, both reduces the comfort feeling of the garments. Decreasing or even removing medullation could be a possible selection objective in alpaca breeding programs for increasing economic value of the alpaca fiber. Therefore, the present work aimed to estimate genetic parameters regarding medullation traits, as well as the genetic correlations with other economical important traits, to be able to select the appropriate criteria to reduce or remove medullation on alpaca fiber and help to reduce the prickle factor in the garments. The data was collected from 2000 to 2017 and belonged to the Pacomarca experimental farm. There were 3698 medullation records corresponding to 1869 Huacaya and 414 Suri genetic types. The fiber samples were taken from the mid side, and were analyzed in an OFDA 100® device. The traits analyzed were percentage of medullation (PM), medullated fiber diameter (MFD), FD, standard deviation of FD, greasy fleece weight as fiber traits; density, crimp in Huacaya and lock structure in Suri, head conformation, leg coverage as morphological traits; weaning weight and age at first calving as secondary and functional traits. Genetic parameters were estimated via a multitrait restricted maximum likelihood. The heritabilities for PM and MFD were 0.225 and 0.237 in Huacaya genetic type and 0.664 and 0.237 in Suri genetic type, respectively; heritabilities for other traits were moderate for productive and morphological traits, and low to moderate for secondary and functional traits. The genetic correlations PM-FD and MFD-FD were high and favorable in both genetic types, between 0.531 and 0.975; the genetic correlation PM-MFD was 0.121 in Huacaya and 0.427 in Suri. The rest of genetic correlations with other traits were in general moderate and favorable. The repeatabilities were 0.556 and 0.668 for PM, and 0.322 and 0.293 for MFD in Huacaya and Suri genetic types, respectively. As a conclusion, PM was identified to be a good selection criterion, probably combined in an index with FD to reduce prickling factor.

The energetic physiology of juvenile mussels, Mytilus chilensis (Hupe): The prevalent role of salinity under current and predicted pCO2 scenarios

As a result of human activities, climate forecasts predict changes in the oceans pCO₂ and salinity levels with unknown impacts on marine organisms. As a consequence, an increasing number of studies have begun to address the individual influence of pCO₂ and salinity but much remains to be done to understand their combined effects on the physiology and ecology of marine species. Our study addressed this knowledge gap by measuring the influence of current and predicted levels of pCO₂ (380 and 1200 ppm, respectively) and salinity (20, 25 and 30 psμ) on the energetic physiology of juvenile mussels (Mytilus chilensis) from the south-eastern Pacific region. Our results indicate that a reduced salinity caused a significant reduction in clearance rate, absorption efficiency and scope for growth of this species. Meanwhile, an increase in pCO₂ levels caused a reduction in excretion rates and interacted significantly with salinity in the rate of oxygen uptake measured in the mussel. These results suggest that potential changes in salinity might have a direct role on the physiology of M. chilensis. The effect of pCO₂, although less prevalent among the variables measured here, did interact with salinity and is also likely to alter the physiology of this species. Given the ecological and economic importance of M. chilensis, we call for further studies exploring the influence of pCO₂ across a wider range of salinities.

Enhanced shelf-life of the formulated biocontrol agent Bacillus amyloliquefaciens CPA-8 combining diverse packaging strategies and storage conditions

Two effective biocontrol products (named as BA3 and BA4) based on Bacillus amyloliquefaciens CPA-8 have been reported as a potential alternative to chemical applications against brown rot caused by Monilinia spp. on stone fruit. To have practical use, this study aimed to describe the best packaging strategies (bags or flasks, atmosphere, and temperature of storage) to not only guarantee efficacy but also stability and ease of application of the products to be handled through the normal channels of distribution and storage. In terms of the viability neither the BA3 nor the BA4 product has been compromised after twelve months of storage. However, storage at 4 °C affected the stability and visual aspect of both CPA-8 formulations, mainly associated not only to the increase of RH but also a_w. Moreover, it should be pointed out that flasks did not conserve refrigerated BA3 samples in a suitable way, since RH and a_w increased noticeably making their visual properties unsightly after 10 months of cold storage. At that time, the BA4 products were better preserved at 4 °C when packaged in flasks. Finally, this study also demonstrated that the most suitable packaging conditions for long-term storability (stored at 22 °C) did not show any negative effect in the biocontrol efficacy of CPA-8 in nectarines artificially infected with M. fructicola and provide suitable product delivery and field application. In conclusion, these results contribute to the final stage of development of these two CPA-8 products, practically ready for registration, thus contributing to the environmental-friendly management of postharvest diseases in stone fruit.

The My Child Matters Programme: The Effect of the Implementation of a Childhood Cancer Care Network (ReNaCI) in the Treatment Abandonment of Acute Lymphoblastic Leukemia in Paraguay

Background: In Paraguay, a low-middle income country (GDP per capita of USD 4,728.7), pediatric cancer is the second cause of mortality in children and adolescents 5-19 years of age. There are approximately 300 new cases of pediatric cancer per year. The Pediatric Cancer Center (PCC) of the School of Medicine (SoM) receives 120 new cases per year, of which 40% correspond to acute lymphoblastic leukemia (ALL). Treatment abandonment is the interruption of patient contact with the health personnel and the treatment of more than 30 days after treatment initiation. At our cancer center, ALL treatment abandonment has been a serious problem. The rates were as high as 20% in 2006, lowering to 17.5% in 2008. To prevent abandonment at our center, we assessed the risk for abandonment, then, we concentrated in three basic interventions: review of compliance with appointment, training of parents and teachers, and access for care at satellites clinics closer to home. For missed appointment, parents are contacted via telephone, or through home visits; and in occasions assistance of child protection services was solicited. We systematically trained parents in the importance of the adherence to cancer treatment. Since 2009, we implemented a comprehensive system for referrals of new cases and follow-up by establishing the ReNaCI, (Red Nacional de Atencion al Cancer Infantil) network. Essential funds for building and sustaining the network has been provided by My Child Matters program under the auspices of Sanofi Espoir Fundation, Paris, France. Currently, as part of this network, there is 4 regional pediatric clinics for early cancer detection, referral, treatment, social assistance and follow up of pediatrics patients with cancer. Aim: Assess the effect of the network in the percentage of abandonment of treatment in patients with ALL treated at the PCC of the SoM in Asunción. Methods: We conducted a longitudinal descriptive study of children diagnosed with ALL at the PCC of the SoM between January 2009 and December 2017. We analyzed the percentage of abandonment since the implementation of the ReNACI network and compared with historical data. Results: From January 2009 to December 2017, 396 new patients with ALL diagnose at the PCC of the SoM. More than 70% of the families were evaluated as having an elevated social risk for abandonment. Abandonment rate decreased from 17.5% in 2008, in 2010%-1.96%, and since 2011 there were no abandonment. However, we still observed in the study period 12% of missed appointments to continue the treatment protocol. Conclusion: The ReNaCI network allowed a successful implementation of interventions to address abandonment by establishing a systems of satellite clinics for a medical and social support for the child and his family closer to home during the entire treatment period. But, despite the achievements, a continuous monitoring is still required to sustain the success of our intervention. Funding: Sanofi Espoir Foundation

Efficacy of environmental friendly disinfectants against the major postharvest pathogens of stone fruits on plastic and wood surfaces

Disinfection of surface facilities during postharvest handling operation is an important practice to avoid secondary fruit infections at stone fruit packinghouses. The aim of this work was to evaluate the effect of six environmental friendly disinfectants against Monilinia fructicola, Penicillium expansum, Rhizopus spp., and Alternaria spp. on plastic and wood surfaces. Hydrogen peroxide, peracetic acid, sodium hypochlorite, Mico-E-pro®, Proallium FRD-N®, and DMC Clean-CNS® were used as the disinfectants. Untreated and surfaces treated with water were used as controls. Plastic and wood surfaces were sampled with Rodac plates at 2 and 24 h after treatments and the number of colonies were counted. In general, all disinfectants reduce the number of viable conidia from all studied surfaces. Hydrogen peroxide used in a concentration of 150 mg L^-1 was the less effective disinfectant in all studied pathogens. The commercial product Mico-E-pro® composed of oregano, onion, and orange extract at a dose of 10 mg L^-1 was the most effective disinfectant. Rhizopus spp. was the pathogen more resistant to the disinfectants followed by P. expansum, M. fructicola, and Alternaria spp. Water decreased the number of conidia adhered to the surface. In addition, the untreated control showed substantial conidia reduction after 24 h of artificial inoculation.

Concentrations of Mercury and Other Inorganic Ions in Wet Precipitation Collected from a Mountain Mining Zone and an Urban Area in Central Mexico

We measured and compared mercury (Hg) and other ions in rainwater collected in San Joaquin (mining zone) and Juriquilla (urban area), central Mexico, from 2009 to 2012. A total of 274 rainwater samples were collected and analyzed for pH, electrical conductivity, [Formula: see text] Cl^-, [Formula: see text] Na⁺, K⁺, Ca²⁺, Mg²⁺ and Hg. Mercury concentrations in rainwater varied from 24.21 to 248.89 (x-bar = 86.97 ± 10.77) µg L^- 1 in San Joaquin (mining zone) and 11.26 to 176.91 (x-bar = 81.51 ± 10.24) µg L^- 1 in Juriquilla (urban area). Rainwater sample were collected over periods 1-3 days, depending upon precipitation frequency. Significant correlations (p < 0.05) were found between [Formula: see text] Cl^-, [Formula: see text] Na⁺, K⁺, Ca²⁺, Mg²⁺ and Hg at the San Joaquin site. Significant correlations were obtained between [Formula: see text] Na⁺, K⁺, Ca²⁺, Mg²⁺ and Hg at the Juriquilla site. In order to determine if there were significant differences among each measured parameter in rainwater collected in San Joaquin and Juriquilla, Kruskal-Wallis test was applied to data. We emphasized that the distribution and concentrations of Hg and the studied ions in rainwater samples were affected by atmospheric dust and local meteorological conditions of wind-speed and direction.

3D curved multiplanar cone beam CT reconstruction for intracochlear position assessment of straight electrodes array. A temporal bone and clinical study

A retrospective review of post-op cone beam CT (CBCT) of 8 adult patients and 14 fresh temporal bones that underwent cochlear implantation with straight flexible electrodes array was performed to determine if the position of a long and flexible electrodes array within the cochlear scalae could be reliably assessed with CBCT. An oto-radiologist and two otologists examined the images and assessed the electrodes position. The temporal bone specimens underwent histological analysis for confirm the exact position. The position of the electrodes was rated as scala tympani, scala vestibule, or intermediate position for the electrodes at 180°, 360° and for the apical electrode. In the patient group, for the electrodes at 180° all observers agreed for scala tympani position except for 1 evaluation, while a discrepancy in 3 patients both for the 360° and for the apical electrode assessment were found. In five temporal bones the evaluations were in discrepancy for the 180° electrode, while at 360° a disagreement between raters on the scalar positioning was seen in six temporal bones. A higher discrepancy between was found in assessment of the scalar position of the apical electrode (average pairwise agreement 45.4%, Fleiss k = 0.13). A good concordance was found between the histological results and the consensus between raters for the electrodes in the basal turn, while low agreement (Cohen's k 0.31, pairwise agreement 50%) was found in the identification of the apical electrode position confirming the difficulty to correct identify the electrode position in the second cochlear turn in temporal bones. In conclusion, CBCT is a reliable radiologic exam to correctly evaluate the position of a lateral wall flexible array in implanted patients using the proposed imaging reconstruction method, while some artefacts impede exact evaluation of the position of the apical electrode in temporal bone and other radiological techniques should be preferred in ex vivo studies.

Intraoperative Conebeam CT for Assessment of Intracochlear Positioning of Electrode Arrays in Adult Recipients of Cochlear Implants

BACKGROUND AND PURPOSE

Intraoperative conebeam CT has been introduced into the operating room and provides quick radiologic feedback. This study aimed to investigate its utility in the assessment of the positioning of the electrode array after cochlear implantation.

MATERIALS AND METHODS

This was a retrospective study of 51 patients (65 ears) with intraoperative imaging by conebeam CT (O-arm) after cochlear implantation between 2013 and 2017. Correct placement into the cochlea was immediately identified. Positioning assessments were later analyzed with OsiriX software.

RESULTS

Intraoperative imaging was quickly performed in all cases. No misplacement into the vestibule or semicircular canals was found. A foldover of the implanted array was identified in 1 patient. Secondary analysis by 2 raters showed excellent agreement on insertion depth angle (intraclass correlation = 0.96, P < .001) and length of insertion of the electrode array (intraclass correlation coefficient = 0.93, P = .04) measurements. The evaluation of the number of extracochlear electrodes was identical between the 2 raters in 78% of cases (Cohen κ = 0.55, P < .001). The scalar position was inconsistent between raters. When we compared O-arm and high-resolution CT images in 14 cases, the agreement was excellent for insertion depth angle (intraclass correlation coefficient = 0.97, P < .001) and insertion length (intraclass correlation coefficient = 0.98, P < .001), good for the number of extracochlear electrodes (Cohen κ = 0.63, P = .01), but moderate for the scalar position (Cohen κ = 0.59, P = .02).

CONCLUSIONS

Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.

Comparative Study of Vitrectomy with and without Vein Decompression for Branch Retinal Vein Occlusion: A Pilot Study

Purpose

To report the clinical outcomes in patients undergoing pars plana vitrectomy with and without vein decompression for treatment of branch retinal vein occlusion (BRVO).

METHODS

Thirty-five eyes with macular edema and visual acuity worse than 20/100 secondary to BRVO were prospectively evaluated. Vitrectomy with posterior hyaloid removal and vein decompression at the arteriovenous crossing was performed on 15 eyes (Group 1); consecutively, the same technique without vein decompression was performed on 20 eyes (Group 2). Primary outcome was visual acuity and secondary outcomes were resolution of macular edema and development of neovascularization.

Results

No differences were found between groups in either patient age (p=0.566) or preoperative visual acuity (p=0.505). No differences were found in visual acuity at 3 (p=0.651), 6 (p =0.697), 9 (p =0.763), 12 (p=0.881), or 18 (p=0.748) months. Mean time for macular edema resolution and visual acuity improvement was 9 months in both groups, with a mean improvement of 3.5 ± 2.35 lines in Group 1 and 3.2 ± 2.97 lines in Group 2. No eyes in either group developed new vessels.

CONCLUSIONS

Results suggest that vitrectomy with posterior hyaloid removal without vein decompression can resolve macular edema, improve vision, and prevent development of new vessels in BRVO.

Assessing Genetic Diversity in Four Stink Bug Species, Chinavia hilaris, Chlorochroa uhleri, Chlorochroa sayi, and Thyanta pallidovirens (Hemiptera: Pentatomidae), Using DNA Barcodes

Stink bugs (Hemiptera: Pentatomidae) are an economically important group of insects that attack numerous crops in the central valley of California. Management of these pests using pheromones or biological control can be species specific, and proper identification of insect species is essential for effective management. The objective was to examine genetic variability in four species of stink bugs, which included Chinavia hilaris (Say) (= Acrosternum hilare) (Hemiptera: Pentatomidae) , Chlorochroa uhleri (Stål) (Hemiptera: Pentatomidae) , Chlorochroa sayi (Stål) (Hemiptera: Pentatomidae), and Thyanta pallidovirens (Stål) (Hemiptera: Pentatomidae) and to determine whether there may be cryptic species present. Stink bugs were collected in pistachios or on adjacent vegetation when abundant in the central valley of California. The mitochondrial DNA cytochrome oxidase I (COI) gene region (i.e., the barcode) was sequenced for each individual. Data were combined with available GenBank accessions for each species and used to construct a phylogenetic tree. Divergence between genera ranged from 11.2 to 15.7%, whereas divergence between the two Chlorochroa spp. was 4.6%. Genetic variation within Chinavia hilaris collections was up to 4.7%, which suggests the presence of a cryptic species. Genetic divergence was highest between individuals of Chinavia hilaris from the west coast and the east coast of the United States. In contrast, genetic variation within individuals of C. uhleri and Ch. sayi was less than 1%. Nine haplotypes were found for Chinavia hilaris, five for C. uhleri, three for Ch. sayi, and five for T. pallidovirens. The relevance of correct species identification and genetic diversity to stink bug management practices was discussed.

The anti-CD6 antibody itolizumab provides clinical benefit without lymphopenia in rheumatoid arthritis patients: results from a 6-month, open-label Phase I clinical trial

Itolizumab is a humanized anti-CD6 monoclonal antibody (mAb) that has previously shown encouraging results, in terms of safety and positive clinical effects, in a 6-week monotherapy clinical trial conducted in rheumatoid arthritis (RA) patients. The current Phase I study evaluated the safety and clinical response for a longer treatment of 12 itolizumab intravenous doses in subjects with active RA despite previous disease-modifying anti-rheumatic drug (DMARD) therapy. Twenty-one subjects were enrolled into four dosage groups (0·1, 0·2, 0·4 and 0·8 mg/kg). Efficacy end-points including American College of Rheumatology (ACR)20, ACR50 and ACR70 response rates and disease activity score in 28 joints (DAS28) were monitored at baseline and at specific time-points during a 10-week follow-up period. Itolizumab was well tolerated up to the highest tested dose. No related serious adverse events were reported and most adverse events were mild. Remarkably, itolizumab treatment did not produce lymphopenia and, therefore, was not associated with infections. All patients achieved a clinical response (ACR20) at least once during the study. Eleven subjects (55%) achieved at least a 20% improvement in ACR just 1 week after the first itolizumab administration. The clinical response was observed from the beginning of the treatment and was sustained during 24 weeks. The efficacy profile of this 12-week treatment was similar to that of the previous study (6-week treatment). These results reinforce the safety profile of itolizumab and provide further evidence on the clinical benefit from the use of this anti-CD6 mAb in RA patients.

Treatment Efficacy, Adherence, and Quality of Life Among Women Younger Than 35 Years in the International Breast Cancer Study Group TEXT and SOFT Adjuvant Endocrine Therapy Trials

Purpose To describe benefits and toxicities of adjuvant endocrine therapies in women younger than 35 years with breast cancer (n = 582) enrolled in the Suppression of Ovarian Function Trial (SOFT) and Tamoxifen and Exemestane Trial (TEXT). Methods In SOFT, women still premenopausal after surgery with or without chemotherapy were randomly assigned to tamoxifen alone, tamoxifen plus ovarian function suppression (OFS), or exemestane plus OFS. In TEXT, all received OFS with or without concomitant chemotherapy and were randomly assigned to exemestane plus OFS or tamoxifen plus OFS. We summarize treatment efficacy, quality of life, and adherence of the cohort of women younger than 35 years in SOFT and TEXT, alongside data from the cohort of older premenopausal women. Results For 240 human epidermal growth factor receptor 2-negative patients younger than 35 years enrolled in SOFT after receiving chemotherapy, the 5-year breast cancer-free interval (BCFI) was 67.1% (95% CI, 54.6% to 76.9%) with tamoxifen alone, 75.9% with tamoxifen plus OFS (95% CI, 64.0% to 84.4%), and 83.2% with exemestane plus OFS (95% CI, 72.7% to 90.0%). For 145 human epidermal growth factor receptor 2-negative patients younger than 35 years in TEXT, 5-year BCFI was 79.2% (95% CI, 66.2% to 87.7%) with tamoxifen plus OFS and 81.6% (95% CI, 69.8% to 89.2%) with exemestane plus OFS. The most prominent quality of life symptom for patients younger than 35 years receiving OFS was vasomotor symptoms, with the greatest worsening from baseline at 6 months (on the order of 30 to 40 points), but loss of sexual interest and difficulties in becoming aroused were also clinically meaningful (≥ 8-point change). The level of symptom burden was similar in older premenopausal women. A total of 19.8% of women younger than 35 years stopped all protocol-assigned endocrine therapy early. Conclusion In women younger than 35 years with hormone receptor-positive breast cancer, adjuvant OFS combined with tamoxifen or exemestane produces large improvements in BCFI compared with tamoxifen alone. Menopausal symptoms are significant but are not worse than those seen in older premenopausal women.

Antimicrobial activity of a new synthetic peptide loaded in polylactic acid or poly(lactic-co-glycolic) acid nanoparticles against Pseudomonas aeruginosa, Escherichia coli O157:H7 and methicillin resistant Staphylococcus aureus (MRSA)

Nanocarrier systems are currently being developed for peptide, protein and gene delivery to protect them in the blood circulation and in the gastrointestinal tract. Polylactic acid (PLA) and poly(lactic-co-glycolic) acid (PLGA) nanoparticles loaded with a new antimicrobial GIBIM-P5S9K peptide were obtained by the double emulsion solvent extraction/evaporation method. PLA- and PLGA-NPs were spherical with sizes between 300 and 400 nm for PLA and 200 and 300 nm for PLGA and <0.3 polydispersity index as determined by dynamic light scattering and scanning electron microscopy), having the zeta potential of >20 mV. The peptide-loading efficiency of PLA-NP and PLGA-NPs was 75% and 55%, respectively. PLA- and PLGA-NPs released around 50% of this peptide over 8 h. In 10% human sera the size of peptide loaded PLA- and PLGA-NPs increased between 25.2% and 39.3%, the PDI changed from 3.2 to 5.1 and the surface charge from -7.15 to 14.6 mV. Both peptide loaded PLA- and PLGA-NPs at 0.5 μM peptide concentration inhibited the growth of Escherichia coli O157:H7 (E. coli O157:H7), methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas. aeruginosa (P. aeruginosa). In contrast, free peptide inhibited at 10 μM but did not inhibit at 0.5 and 1 μM. These PLA- and PLGA-NPs presented <10% hemolysis indicating that they are hemocompatible and promising for delivery and protection system of GIBIM-P5S9K peptide.

Whole Genome Sequence and Phylogenetic Analysis Show Helicobacter pylori Strains from Latin America Have Followed a Unique Evolution Pathway

Helicobacter pylori (HP) genetics may determine its clinical outcomes. Despite high prevalence of HP infection in Latin America (LA), there have been no phylogenetic studies in the region. We aimed to understand the structure of HP populations in LA mestizo individuals, where gastric cancer incidence remains high. The genome of 107 HP strains from Mexico, Nicaragua and Colombia were analyzed with 59 publicly available worldwide genomes. To study bacterial relationship on whole genome level we propose a virtual hybridization technique using thousands of high-entropy 13 bp DNA probes to generate fingerprints. Phylogenetic virtual genome fingerprint (VGF) was compared with Multi Locus Sequence Analysis (MLST) and with phylogenetic analyses of cagPAI virulence island sequences. With MLST some Nicaraguan and Mexican strains clustered close to Africa isolates, whereas European isolates were spread without clustering and intermingled with LA isolates. VGF analysis resulted in increased resolution of populations, separating European from LA strains. Furthermore, clusters with exclusively Colombian, Mexican, or Nicaraguan strains were observed, where the Colombian cluster separated from Europe, Asia, and Africa, while Nicaraguan and Mexican clades grouped close to Africa. In addition, a mixed large LA cluster including Mexican, Colombian, Nicaraguan, Peruvian, and Salvadorian strains was observed; all LA clusters separated from the Amerind clade. With cagPAI sequence analyses LA clades clearly separated from Europe, Asia and Amerind, and Colombian strains formed a single cluster. A NeighborNet analyses suggested frequent and recent recombination events particularly among LA strains. Results suggests that in the new world, H. pylori has evolved to fit mestizo LA populations, already 500 years after the Spanish colonization. This co-adaption may account for regional variability in gastric cancer risk.

Ranpirnase eradicates human papillomavirus in cultured cells and heals anogenital warts in a Phase I study

BACKGROUND

Human papillomaviruses (HPV), the causative agents of anogenital warts, are the most prevalent sexually transmitted infectious agents, and wart treatment poses a persistent challenge. We assessed the safety and efficacy of treating HPV with ranpirnase, an endoribonuclease from the northern leopard frog that has been used extensively in Phase III oncology trials.

METHODS

As initial verification of ranpirnase antiviral activity, we assessed its ability to eliminate papillomaviruses in cultured cells. To further assess its feasibility for treating anogenital warts in humans, we performed a Phase I study. Forty-two male volunteers with genital/perianal warts were treated topically with three different formulations of 1 mg/ml ranpirnase. Patients were monitored for 8 weeks or until healing. Four patients with HIV were treated in accordance with the compassionate programme but were not evaluated.

RESULTS

In cultured cells, ranpirnase showed specific activity against HPV-11 with low toxicity (selectivity index >88). The broad applicability of ranpirnase for treating papillomaviruses was verified using the cottontail rabbit papillomavirus. In the clinical study, eight participants were lost-to-follow-up or discontinued due to protocol violation or non-compliance. Among 30 evaluable participants, topical ranpirnase was moderately well-tolerated, with discontinuation by 5 (16.7%) due to adverse reactions. Clinical healing was achieved by 25 participants (83.3%) and 50% improvement by the 5 discontinued participants (16.7%). The median time to clinical healing was 30 days.

CONCLUSIONS

This study provides the first in vitro and clinical evidence of the antiviral efficacy of ranpirnase against HPV and supports assessment of ranpirnase in expanded clinical studies.